The Trendelenburg position It is a modification of the supine or lying position, which is achieved by placing the individual on a bed that tilts up to approximately 45 °, so that the head is on a lower axis than the feet.
It was popularized in the early years of the 20th century by Dr. Friedrich Trendelenburg (1844-1924), who used it routinely to facilitate surgical procedures in the pelvic area.
It is one of the most frequently used positions during tummy tuck and pelvic surgery, both open and laparoscopic. By positioning the patient with this inclination, the abdominal content is mobilized towards the diaphragm, clearing the pelvic cavity, which makes it easier for the surgeon to access..
Although it is usually also used in patients who have suffered a collapse due to a decrease in blood pressure, its benefit in these cases is not scientifically proven.
The reasoning of those who use the Trendelenburg position for the treatment of syncope due to hypotension is that placing the legs above the head facilitates the return of blood and the patient regains consciousness..
Being a position that is used mainly in anesthetized individuals, it is important that the health team knows how to properly position the patient and recognize any abnormality in their cardiovascular and pulmonary status to avoid complications.
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Trendelenburg is the eponymous for the position and is used in honor of the person who described it, Dr. Friedrich Trendelenburg (1844-1924). This was a German surgeon who basically did pelvic surgery. By following this line of study, most of his clinical contributions have to do with procedures in that area.
Among his many contributions in the area of surgery and anesthesiology, is the description of a position that facilitated surgery of the pelvic organs.
Although he was not the first to describe the position, he was the one who popularized it at the beginning of the 20th century, considering it an important tool for exposing organs in pelvic surgery.
The position consists of placing the patient lying down with the feet higher than the head. In Dr. Trendelenburg's description, the patient's legs were off the table. However, today the patient is positioned with his whole body on the surface of the bed.
The patient must be in a supine position, lying on his back, on a movable bed that is capable of tilting more than 30 °.
In this way, the doctor mobilizes the surface until reaching the desired position. The description indicates that there must be a 45 ° inclination, with the head being below the axis of the feet.
The opposite position, in which the inclination favors the upper part of the body, leaving the head above the feet, is known as Inverted Trendelenburg.
The Trendelenburg position is a fairly safe position for the patient from an organic and metabolic point of view
However, it must be taken into account that when the bed is tilted with the anesthetized patient, it can move and fall. Therefore, it should be secured with a belt or safety tape at hip level or a little lower..
It is recommended to place a padded material under the knee joint, so that they are in semi-flexion and thus avoid injuries due to muscle elongation..
It is important that the arms are resting completely on the armrests. At the wrist level, the upper limbs should also be secured with safety straps or braces to prevent the arms from falling violently during the procedure..
The Trendelenburg position allows, through gravity, the intra-abdominal organs to move towards the diaphragm.
This movement opens the pelvic space facilitating the performance of surgical procedures, such as hysterectomy or the removal of ovarian tumors..
The American Association of Anesthesiology (ASA) recommends the Trendelenburg position as ideal for catheterization of central venous accesses. These are special passageways, which are placed in the neck at the level of the subclavian vein for administration of treatment and measurement of central venous pressure..
Although there is no scientific evidence, either for or against, of the use of this position in patients suffering from hypotensive syncope, theoretically there is a benefit due to the fact that raising the legs and keeping the patient's head in a lower plane , there is an increase in venous return, which is the amount of blood that returns from the lower limbs to the brain.
Thus, when an individual faints and the cause is a decrease in blood pressure, this position helps him to regain his state of consciousness.
Within the preparation of the patient in the pre-operative period, the pulmonary evaluation is one of the main ones to take into account in a patient who requires a procedure in which he must be placed in this position..
By tilting the patient, leaving the head on an axis lower than that of the feet, the internal organs put pressure on the diaphragm.
Under normal conditions, the pressure exerted by the organs is not strong enough to cause a respiratory complication. However, in those patients with underlying respiratory conditions, it can decrease diaphragmatic mobility and lead to acute respiratory failure..
If it is absolutely necessary to position a patient with respiratory problems in this way, the anesthesiologist must be aware of any changes in oxygen saturation, or amount of oxygen in the patient's blood..
In case there is evidence of a decrease in respiratory capacity, the doctor should horizontalize the patient and take the necessary measures to regain normal respiratory condition..
The main advantage of the Trendelenburg position is seen in surgical procedures of the pelvis, since this cavity is narrow and the intestinal loops obstruct visibility.
When the patient is tilted, the small intestine is moved towards the diaphragm and the pelvic cavity is cleared to operate comfortably and without danger of injuring the intestinal loops..
A disadvantage is observed in the case of simultaneous surgical procedures. For example, one team of surgeons operates on a pelvic tumor and another on the gallbladder of the same patient. In this situation, the Trendelenburg position would hinder the team that works on the abdomen, so it is not recommended to perform pelvic surgeries and intra-abdominal surgeries simultaneously..
This position has been seen to increase blood pressure, therefore it should be avoided in those patients with high blood pressure. Likewise, intracranial and ocular pressures are increased.
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